Abstract

Adolescent musculoskeletal pain is common and is associated with musculoskeletal pain in adulthood. Psychological symptoms, also common in adolescence, have been shown to be associated with musculoskeletal pain, but the current evidence is mixed and may be dependent on effect modifiers. This study investigated whether adolescents with psychological symptoms (internalizing and externalizing constructs) at age 13 years were at higher odds for musculoskeletal pain at age 17 years and whether the associations were modified by pubertal status and sex. A prospective cohort design examined data on 3865 adolescents from the Avon Longitudinal Study of Parents and Children (ALSPAC). Associations between baseline (aged 13 years) internalizing and externalizing symptoms and musculoskeletal pain at follow-up (aged 17 years) were investigated using logistic regression producing odds ratios (OR) and 95% confidence intervals (95% CI). In total 43.1% of adolescents reported musculoskeletal pain at follow-up. Externalizing symptoms at baseline increased the odds of musculoskeletal pain (OR 1.68, 95% CI 1.28, 2.20), and internalizing symptoms demonstrated a non-significant increase (OR 1.26, 95% CI 0.98, 1.62). Effect modification analysis showed an increased effect dependent on pubertal status.Conclusion: Adolescents with externalizing symptoms, and to some extent internalizing symptoms, are at increased odds of later musculoskeletal pain. Future research is now required to understand the reasons for these associations.What is Known:• Current evidence regarding the association between internalizing symptoms and externalizing symptoms and future musculoskeletal pain in adolescents is mixed.What is New:• This study found that adolescents with externalizing symptoms, and to some extent internalizing symptoms, are at increased odds for musculoskeletal pain, with an increased influence dependent on pubertal status.• These results are of interest for the development of timely preventative interventions designed to reduce the risk of musculoskeletal pain.

Highlights

  • ParticipantsMusculoskeletal pain is common in adolescence, with estimates up to 40% globally [1]

  • This study found that adolescents with externalizing symptoms, and to some extent internalizing symptoms, are at increased odds for musculoskeletal pain, with an increased influence dependent on pubertal status

  • Adolescent musculoskeletal pain is associated with a high burden in terms of years lived with disability [2] and later musculoskeletal pain in adulthood

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Summary

Introduction

ParticipantsMusculoskeletal pain is common in adolescence, with estimates up to 40% globally [1]. One is psychological symptom type, with differences reported dependent on whether symptoms are internalizing (e.g. depression and anxiety) or externalizing (e.g. attentiondeficit-hyperactivity disorders and behavioural problems) [14,15,16, 18, 19]. Another explanation is potential effect modification dependent on sex; one of three studies [17, 19, 20] investigating sex reported a significant association for internalizing symptoms in girls but not boys, and for externalizing symptoms in boys but not girls [20]. The aim of this study was to prospectively test whether internalizing and externalizing symptoms in adolescents were predictive of musculoskeletal pain and to investigate whether sex and pubertal status modify these associations

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